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Assessing the functional outcomes of ankle fracture and its predictive factors
following surgical treatment at Addis Ababa burn, emergency, and trauma
(AaBET) hospital, Addis Ababa...

Article in European Journal of Orthopaedic Surgery & Traumatology · June 2022

DOI: 10.1007/s00590-022-03283-2

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European Journal of Orthopaedic Surgery & Traumatology
https://doi.org/10.1007/s00590-022-03283-2

ORIGINAL ARTICLE

Assessing the functional outcomes of ankle fracture and its predictive

factors following surgical treatment at Addis Ababa burn, emergency,
and trauma (AaBET) hospital, Addis Ababa, Ethiopia, 2021: A 5‑year
retrospective cross‑sectional study
Anteneh Damena Kelemework1 · Abiy Worku Haile1 · Samuel Debas Bayable2

Received: 17 March 2022 / Accepted: 1 May 2022

© The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2022

Abstract
Background Ankle fracture is a common injury that is treated at Addis Ababa Burn, Emergency, and Trauma Hospital.
Previous studies show that there are mixed functional outcomes after surgically treated ankle fractures.
Methods After Ethical clearance was obtained from the ethical review committee of St. Paul Millennium Medical College,
a retrospective cross-sectional study was conducted on 122 patients from September to October 2021. Patients fulfilling the
inclusion criteria were called through phone and verbal consent was obtained, and the patients’ responses were recorded
with Olerud and Molander ankle outcome score (OMAS). For those study subjects who were unanswered to phone calls or
non-functioning cell phones were repeated at least two times per week during the data collection period.
The collected data were coded, entered, checked for its completeness, cleaned, and analyzed using SPSS Version 22. Descrip-
tive statistics were presented with frequency, percentage, text, and graphs. Finally, the strength of association between func-
tional outcome of ankle fracture and independent variables were evaluated using the Chi-square test, and a P-value < 0.05
was declared to be statistically significant.
Results Out of the total 122 patients, 72.1% of study subjects were males, and the mean OMAS for males and females was
76.79, and 75.65, respectively. Among all ankle fractures, nearly two-thirds (63.1%) of them were closed fractures, which
are initially stabilized with splinting, open reduction, and internal fixation (ORIF), and external fixation were 77%, 13.9%,
and 9%, respectively, whereas 83.3% definitive management of operatively treated ankle fracture was open reduction and
internal fixation.
In this study, the score of Olerud and Molander was 82.9% patients ‘good’ or ‘excellent,’ whereas 10.5% and 4.5% were fair
and poor, respectively. In the present study patients with 40 years and younger (p-value, 0.022) and early surgical treatment
(p-value 0.02) were strongly associated with the positive functional outcome of ankle surgery.
Conclusion Even though the surgical treatment of ankle fracture results in good postoperative functional outcomes, restores
ankle function, and allows good mobility of the ankle joint, still some patients experience few restrictions in functional
activities of 2–5-year post-surgical treatment.

Keywords Ankle fractures · Functional outcome of ankle surgery · Orthopedics · Outcome assessment

Abbreviations Background
AaBET Addis Ababa burn, emergency and trauma
OMAS Olerud and molander score Ankle is a precisely aligned joint with little soft tissue cover-
ORIF Open reduction and internal fixation age that is transiently exposed to forces of 1.25 times and 5.5
times body weight with a normal gait and vigorous activi-
ties, respectively [1, 2]. A normal ankle requires adequate
dorsiflexion, plantar flexion, inversion, and eversion, as well
as accommodation to rotational during stresses, provided
* Samuel Debas Bayable
by the subtalar joint, but the ankle is not intrinsically stable
samueldebas88@yahoo.com
in any position and requires support from the muscles that
Extended author information available on the last page of the article

13
Vol.:(0123456789)

crosses it [1–3]. As result, severe injury combined with inad-
equate or inappropriate treatment leads to severe complica-
tions and major disability [4].
Ankle fractures are common in the lower limb and
account for 10% of the total fractures reported [5, 6]. Dam-
age to the ligaments and the greater trauma to the bones
results in more instability of fractures [7]. Among ankle
fractures, 2% of patients develop open fractures [6] and
mostly affect young men and older women [8], but it is com-
mon below the age of 50 years in males and becomes pre-
dominant in females beyond 50 years. Alcohol and slippery
surfaces are responsible for nearly one-third of the cases [5,
9]. Even if stable ankle fractures are treated with conserva-
tive techniques, open reduction and internal fixation (ORIF)
is the standard of care for unstable ankle fractures [7], and
anatomic restoration of the joint is the goal of management
through the standard care [5, 9].
Statement of the problem
Ankle fractures are common forms of trauma in the world,
and the hip is the most common lower limb fracture [5].
The previous studies worldwide show a great discrepancy
in the occurrence of incidence due to different reasons [3,
5]. Nowadays, the incidence of ankle fractures is sharply
increased in line with the aging demographic of most west-
ern populations, which is supported by a study conducted
in Finland that reported an increase of 319% in the over-
all annual number of low-energy ankle fractures in elderly
patients admitted to hospital. Most studies predicted that
the number of low-energy ankle fractures could be tripled
by 2030 [10–12].
Despite ‘lesser’ injury in comparison with other fractures
(such as multiple traumas, hip fractures, or fractures of the
axial skeleton), ankle fractures are restricted to pain and dis-
ability caused at the time of the incident but continue for an
extended duration [13–16]. This potential consideration of
ankle fractures as a lesser injury may be due to a perception
that ankle fractures are localized in nature and have a high
success rate of fracture reduction and union with established
treatment protocols [17, 18].
Long-term effects of ankle fractures have been reported
to include physical, psychological, and negative social con-
sequences and have included difficulty in returning to work
and dependence on disability benefits and social conse-
quences [19].
Some studies have identified that 52 to 87% of patients
have good-to-excellent clinical outcomes after an ankle
fracture [3, 20]. In contrast, some studies looking at patient
outcomes between 14 months and 6 years following frac-
ture have found that few patients reported a full recovery in
most areas[19, 21]. Nilsson, Nyberg et al. found 51% self-
report poor function with complaints of ongoing stiffness
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European Journal of Orthopaedic Surgery & Traumatology
and swelling, pain with walking, and an impaired ability
to climb stairs [22]. Another study of a systematic review
of long-term outcomes on ankle fractures reported that
approximately one in five did not result in a good or excel-
lent outcome [17].
Addis Ababa burns, emergency, and trauma (AaBET)
hospital is overloaded with trauma patients, and ankle frac-
tures constitute a significant percentage and the department
of orthopedics, and traumatology needs baseline study to
know the functional outcome measuring parameters like
pain, swelling, walking, running, and return to previous
health condition after operatively treated ankle fracture.
So this study helps to determine the functional outcome of
ankle fracture following its surgical treatment and provides
baseline information for further studies.
Objectives
General objective
To assess functional outcomes of ankle fracture and its pre-
dictive factors following surgical treatment at Addis Ababa
burn, emergency, and trauma (AaBET) hospital, Addis
Ababa, Ethiopia, 2021.
Specific objective
To assess the functional outcome of ankle fracture following
surgical treatment.
To identify predictive factors with the functional outcome
of ankle fractures.
Methods
Study setting, design, and period
The study was conducted in Addis Ababa burn, emergency,
and trauma (AaBET) hospital, which is one of the largest
tertiary trauma hospitals in the country and is affiliate with
St. Paul Millennium Medical College. It has been giving
services such as neurosurgery, orthopedics, trauma, burn,
emergency, and critical care services since its establishment
in 2015.
After Ethical clearance was obtained from the ethical
review committee of St. Paul Millennium Medical College,
a retrospective cross-sectional study was conducted from
August 2015 to March 2019. The study participants were
identified using the hospital operation registration (MRN)
logbook, then patients’ charts is collected. Data were col-
lected through chart review and phone calls with verbal
consent using the OMAS format as shown (Table 1). For
European Journal of Orthopaedic Surgery & Traumatology

those study subjects who were unanswered to phone calls or percentage, text, and graphs. Shapiro–Wilk normality test
non-functioning cell phones were repeated at least two times was used to check the normality of the data. In this study,
per week during the data collection period. The ankle-spe- normally distributed data were analyzed using Student’s
cific outcome score was devised by Olerud and Molander. independent t test, and then the result was presented as
Olerud Molander ankle score (OMAS) is a well-established mean ± SD (standard deviation), whereas non-normally
self-reported questionnaire, which is considered function- distributed variables were analyzed by Mann–Whitney
ally oriented and is a valid ankle-specific outcome scoring U test, and the result was expressed as median and inter-
system [25]. quartile range. The comparisons of categorical parameters
According to Olerud and Molander score, 0–30, 31–60, were analyzed using the Chi-square test and Fisher’s exact
61–90, and 91–100 were considered ‘poor,’ ‘fair,’ ‘good,’ test as required and expressed in numbers and percentages.
and ‘excellent’ functional outcome, respectively. Finally, the strength of association between OMAS score
All patients who were treated operatively for ankle frac- and independent variables was evaluated using the Chi-
ture at AaBET hospital under the orthopedic and trauma- square test, and a P-value < 0.05 was declared to be statisti-
tology department from August 2015 to March 2019 were cally significant.
included, and patients with concomitant injuries other than
an ankle fracture, pathological fractures, incomplete medi-
cal charts, and patients who are not willing for an interview
Result
were excluded from this study.
The collected data were coded, entered, checked for its
Even though 240 patients with ankle fractures were surgi-
completeness, cleaned, and analyzed using SPSS Version
cally treated at AaBET Hospital from August 2015 to March
22. Descriptive statistics were presented with frequency,
2019, only 122 patients were eligible for this study. The
reasons for exclusion were incomplete documentation [20],
chart not found [9], age below 18 years [3], associated con-
Table 1  Olerud and Molander ankle outcome score
comitant injury (76), and charts without a phone number
Parameter Degree Score(100 [10].
max)
Out of the total, eligible patients’ 72.1% patient were
Pain None 25 male, the majority (59%) of study subjects were below the
While walking on uneven surface 20 age of 40 years, and more than half (53.2%) patients were
While walking on even surface 10 Addis Ababa residents as shown in Table 2, and the mean
While walking indoors 5 age of participants was 38 ± SD 14.7 years.
Constant and Severe 0 Most patients (74.4%) were presented to the hospital on
Stiffness None 10 the same day of injury, while 94% of the patients presented
Present 0 within a week of sustaining an ankle fracture respectively
Swelling None 10 but the rest patients presented with unusually longer periods
Only evenings 5 after ankle fractures greater than one month.
Constant 0
Stair climbing No Problem 10
Pattern and Site of ankle fractures
Impaired 5
Impossible 0
The most common ankle fracture has occurred due to fall-
Running Possible 5
ing down accidents, pedestrian road traffic accidents, and
Impossible 0
violence or fighting injuries account for 39.17%, 25%, and
Jumping Possible 5
12.5%, respectively, as shown in Fig. 1. Among all ankle
Impossible 0
fractures, 63.1% of them were closed and more than half
Squatting No problem 5
(50.8%) of patients affected the left side as shown Fig. 1. The
Impossible 0
most commonly injured bone of the ankle treated operatively
Supports None 10
was combined medical and lateral malleolus fracture (62%),
Strapping used 5
whereas the least common was isolated lateral malleoli frac-
Stick or crutch 0
ture (7%) as shown in Fig. 2.
Work and activities Same as before injury 20
of daily livings The frequency of initial stabilization of ankle fracture in
Loss of tempo 15
AaBET hospital was splinting, open reduction and inter-
Change to a simple job 10
nal fixation (ORIF), and external fixation which were 77%,
Severely impaired work capacity 0
13.9%, and 9%, respectively. Open reduction and internal

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 European Journal of Orthopaedic Surgery & Traumatology

fixation (ORIF) constitutes 83.3% of definitive management
of operatively treated ankle fracture (Fig. 3).
For the patients treated with ORIF, the most common
implants used in medial malleolus fractures were screws
(67%), whereas for lateral malleolus fractures, plates and
screws were common choices (85%). Of the total patients
having a posterior malleolar fracture, 80% do not require
instruments for treatment (Table 4). Among surgical
implants in ankle fractures, the most performed proce-
dures in medial malleolus, lateral malleolus, and posterior
malleolus were screw (67.8%), plate, and screw (84.9%),
and no instrument is used (85%) as shown in Table 3.
In this study, the Olerud and Molander scoring
(OMAS), 82.9% of all fractures score a ‘good’ to ‘excel-
lent,’ whereas 10.5% and 4.5% were fair and poor, respec-
tively (Fig. 4).
The mean OMAS for males is 76.79, while for females, it
is 75.65, and being younger had a good functional outcome
as compared to elders (p-value 0.02), and having early sur-
gery had a better outcome (p-value 0.022) (Table 4).

Fig. 1  Ankle fracture mecha-

nism of injury of surgically
treated ankle fracture patients at
AaBET hospital from 2015 to
2019(N = 122)

Fig. 2  Distribution of malleolus

fracture of surgically treated
ankle fracture patients at
AaBET hospital from 2015 to
2019(N = 122)

Fig. 3  Treatment of ankle

fractures stabilization for
surgically treated patients at
AaBET hospital from 2015 to
2019(N = 122)

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European Journal of Orthopaedic Surgery & Traumatology

Table 2  A socio-demographic characteristic of surgically treated Discussion

ankle fracture patients at AaBET hospital from 2015 to 2019 (N = 122
Variables N % Operative treatment for ankle fractures restores sufficient
stability to allow full mobility at the ankle joint [1]. Mak-
Gender
wana et al. compared ORIF cases with conservatively treated
Female 34 27.9%
ankle fractures and conclude that ORIF treatment has a
Male 88 72. 1%
higher functional outcome score and a significantly better
Age
range of movement of the ankle [23]. Although the current
< 40 years 72 59%
study did not compare the outcome of patients treated con-
≥ 40 years 50 41%
servatively with surgical treatment, study subjects achieve
Residency
good and excellent results in 82.9% of the cases, which is
Addis Ababa 65 53.2%
supported by a study conducted on functional outcome, and
Oromiya 37 30.3%
quality of life in patients with type B ankle fractures shows
Amhara 14 11.5%
76–83% satisfactory outcomes of surgical treatment [23, 24],
SNNP 3 2.6%
but in contradict to a study using the Olerud and Molander
Benishangul Gumuz 2 1.6%
scoring system noted that 93.8% of patients had excellent
Afar 1 0.8%
and good functional outcomes [1].
This study agrees with Egol et al. that patients younger
than 40 years old have significantly better functional out-
The Chi-square test was done to see the strength of comes than those aged beyond 40 years [25]; the possible
association between the functional outcome of surgically explanation might be both studies conducted and through
treated ankle fracture and independent variables like OMAS scoring. However, no significant differences were
delay in surgery, age, gender, type of fracture, diabetes, shown in the functional outcome between patients aged
and smoking habit clearly shown (Table 5). The p-value below 40 years and older than 40 years in the studies per-
of > 0.05 with 95% CI shows that there is no statistically formed by Belcher and Lash (33); the possible difference
significant association between the outcome and the inde- might be the method of study design that is a prospective
pendent variable. cohort study in this research. Even if the present study shows
that men have better functional outcomes than women at

Fig. 4  Patients’ OMA score fol-

lowing ankle fracture stabiliza-
tion at AaBET hospital from
2015 to 2019(N = 122)

Table 3  Type of implant used Medial malleolus Lateral malleolus Posterior malleolus
for lateral, medial, and posterior
malleolus fracture at AaBET Screw 61(67.8 2(2.3%) 1(7.1%)
hospital from 2015 to 2019
Plate and screw 8(8.9 (%) 73(84.9%) 1(7.1%)
(N = 122)
Pinning with K wire 12(13.3%) 4(4.7%) –
Tension Band Wire 4(4.4%) 1(1.2%) –
Stitching 1(1.1%) – –
No instrument used 2(2.2%) 2(2.3%)) 12(85.7%)
Screw and pin 2(2.2%) – –
Rush nail – 4(4.7%) –
Total 90(100%) 86(100%) 14(100%)

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 European Journal of Orthopaedic Surgery & Traumatology

Table 4  Comparisons of mean OMAS scores of ankle fracture surgical patients for ankle fracture$ Please check the clarity
patients with different variables independent variables at AaBET hos- of the phrase ‘this study is only 8% may results’ in the sen-
pital from 2015 to 2019 (N = 122)
tence ‘The timing of early … for ankle fracture $.
Mean OMAS SD P value Smoking history did not influence functional recovery
[26] which supports the present study finding; in addition,
Gender
the presence of diabetes was predicting factors in functional
Male 76.79 19.26 Reference
recovery at one year for surgically treated ankle fracture
Female 75.65 17.98 0.624
patients [25], but this study result shows that there is no
Age
statistically significant association between the presence of
< 40 years 80.11 16.92
diabetes and outcome. The possible reason may be in the
40 years and above 70.52 20.37 0.02
current article, study subjects were assessed at least 2 years
Type of fracture
after surgery or the small proportion of diabetics to non-dia-
Open 72.12 20.75 Reference
betics in this study. (Only 3.6% of the patients are diabetic,
Closed 78.7 17.46 0.138
while for lash et al., 13%.)
Type of fracture
A retrospective study on the most common operative
Lateral malleolar 85 14.14 Reference
method of ankle fractures reported that open reduction and
Medial malleolar 81.54 13.75 0.32
internal fixation (ORIF) is 91.2% followed by external fixa-
Bimalleolar 77.26 17.64 0.28
tion at 8.8%. The most common implants used in medial
Trimalleolar 67.5 23.94 0.26
malleolus fractures were screws 71.6%, whereas for lateral
Time of surgery
malleolus fractures, plates were a common choice (56.1%).
Early 77.39 4.78 Reference
There were no implants used for the posterior malleolus
Late 77.39 17.56 0.022
fractures in their study [1, 3]], which is nearly similar to the
Smoking habit
current study finding; the reason might be similar due to the
Smoker 90 8.66 Reference
study design, proportional sample size, and nearly similar
Non smoker 75.89 18.89 0.158
socioeconomic status of the two countries.
Presence of DM
Diabetic 75 18.7 Reference
Non diabetic 76.55 19.04 0.618
Conclusion

Even though the surgical treatment of ankle fracture results

Table 5  Chi-square test of association between OMAS and independ-
ent variables at AaBET hospital from 2015 to 2019 (N = 122)
Association P-value
OMAS vs gender 0.915
OMAS vs age 0.277
OMAS vs fracture type( number of malleolus) 0.343
OMAS vs smoking habit 0.767
OMAS vs DM 0.686
OMAS vs delay in surgery 0.342
5 years, it is not statistically significant. Lash and Nilsson
et al. conclude that men have a slightly better OMAS score
than women at 2 and 3 years, respectively [26]; the differ-
ence might come from the proportion of study subjects in
the previous study being relatively higher.
The timing of early surgical fixation has no significant
difference in the OMAS at 5 years with an incidence of 40%
[24, 26], which is not in line with the current study the rea-
son may be the incidence of early surgical fixation in this
study is only 8% may results the variable statistically sig-
nificant, and the outcome is better in those early operated
in good postoperative functional outcomes, restores ankle
function, and allows good mobility of the ankle joint, still
some patients experience few restrictions in functional activ-
ities of 2–5 years post-surgical treatment.
Authors' contribution All authors made a significant contribution to
the work reported, whether that is in the conception, study design,
execution, acquisition of data, analysis, and interpretation, or in all
these areas; took part in drafting, revising, or critically reviewing the
article; gave final approval of the version to be published; have agreed
on the journal to which the article has been submitted; and agree to be
accountable for all aspects of the work.
Funding The authors received no financial support for the research
authorship/or publication of this article.
Declarations
Conflict of interest The authors declare that there is no conflict of in-
terest.
Ethics approval and consent to participate Ethical approval was
granted with St. Paul Millennium Medical College, and oral consent
was obtained through a phone call from each study subjects.

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European Journal of Orthopaedic Surgery & Traumatology

References hemiarthroplasty versus conservative treatment for comminuted

fractures of the proximal humerus in the elderly (ProCon): a mul-
ticenter randomized controlled trial. BMC Musculoskelet Disord
1. Ahmad Hafiz Z, Nazri M, Azril M, Kassim N, Nordin N, Daraup
11(1):1–9
S et al (2011) Ankle fractures: the operative outcome. Malaysian
15. Goldhahn S, Kralinger F, Rikli D, Marent M, Goldhahn J (2010)
Orthoped J 5(1):40–43
Does osteoporosis increase complication risk in surgical fracture
2. Regan DK, Gould S, Manoli III-A, Egol KA (2016) Outcomes
treatment? A protocol combining new endpoints for two prospec-
over a decade after surgery for unstable ankle fracture: functional
tive multicentre open cohort studies. BMC Musculoskelet Dis
recovery seen 1 year postoperatively does not decay with time. J
11(1):1–10
Orthoped Trauma 30(7):e236–e241
16. Hallberg I, Bachrach-Lindström M, Hammerby S, Toss G, Ek A-C
3. Lash N, Horne G, Fielden J, Devane P (2002) Ankle frac-
(2009) Health-related quality of life after vertebral or hip frac-
tures: functional and lifestyle outcomes at 2 years. ANZ J Surg
ture: a seven-year follow-up study. BMC Musculoskelet Disord
72(10):724–730
10(1):1–13
4. Hillstrom HJ, Song J, Kraszewski AP, Hafer JF, Mootanah R,
17. Stufkens SA, Van Den Bekerom MP, Kerkhoffs GM, Hintermann
Dufour AB et al (2013) Foot type biomechanics part 1: struc-
B, Van Dijk CN (2011) Long-term outcome after 1822 operatively
ture and function of the asymptomatic foot. Gait Posture
treated ankle fractures: a systematic review of the literature. Injury
37(3):445–451
42(2):119–127
5. Court-Brown CM, Caesar B (2006) Epidemiology of adult frac-
18. Giannini S, Faldini C, Acri F, Leonetti D, Luciani D, Nanni M
tures: a review. Injury 37(8):691–697
(2010) Surgical treatment of post-traumatic malalignment of the
6. Court-Brown CM, McBirnie J, Wilson G (1998) Adult ankle frac-
ankle. Injury 41(11):1208–1211
tures—an increasing problem? Acta Orthop Scand 69(1):43–47
19. van der Sluis CK, Eisma W, Groothoff J, Ten Duis H (1998) Long-
7. Schie-Van der Weert V, Van Lieshout E, De Vries M, Van der Elst
term physical, psychological and social consequences of a fracture
M, Schepers T (2012) Determinants of outcome in operatively and
of the ankle. Injury 29(4):277–280
non-operatively treated Weber-B ankle fractures. Archiv Orthoped
20. Day GA, Swanson CHulcombe EBG (2001) Operative treatment
Trauma Surg 132(2):257–263
of ankle fractures: a minimum ten-year follow-up. Foot & ankle
8. Donken CC, Al-Khateeb H, Verhofstad MH, van Laarhoven CJ
Int 22(2):102–106
(2012) Surgical versus conservative interventions for treating
21. Kennedy J, Johnson S, Collins A, DalloVedova P, McManus W,
ankle fractures in adults. The Cochrane Database of Syst Rev
Hynes D et al (1998) An evaluation of the Weber classification of
8:Cd008470
ankle fractures. Injury 29(8):577–580
9. Jensen SL, Andresen BK, Mencke S, Nielsen PT (1998) Epidemi-
22. Nilsson G, Nyberg P, Ekdahl C, Eneroth M (2003) Performance
ology of ankle fractures: a prospective population-based study of
after surgical treatment of patients with ankle fractures—
212 cases in Aalborg. Denmark Acta Orthopaedica Scandinavica
14-month follow-up. Physiother Res Int 8(2):69–82
69(1):48–50
23. D’Almeida VR, Thomas A, Devasia T, Mathew N, Kamath A,
10. Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M (2008)
Adiga R (2015) Functional outcome following operative treatment
Stabilizing incidence of low-trauma ankle fractures in elderly peo-
of ankle fractures. J Evol Med Dent Sci 4(63):10937–10956
ple: Finnish statistics in 1970–2006 and prediction for the future.
24. Utomo P, Arimuqti Z, Santoso A, Sibarani TS, Anwar IB (2020)
Bone 43(2):340–342
High energy injury ankle fracture-dislocation without neurovas-
11. Kannus P, Palvanen M, Niemi S, Parkkari J, Jrvinen M (2002)
cular involvement. Indonesian J Med 5(3):259–264
Increasing number and incidence of low-trauma ankle fractures
25. Shah N, Sundaram R, Velusamy A, Braithwaite I (2007) Five-
in elderly people: Finnish statistics during 1970–2000 and projec-
year functional outcome analysis of ankle fracture fixation. Injury
tions for the future. Bone 31(3):430–433
38(11):1308–1312
12. Purushotham K, Ranjan S, Mohammed S (2018) Ankle frac-
26. Nilsson GM, Eneroth M, Ekdahl CS (2013) The Swedish version
ture: The operative outcome of 30 patients. Int J Orthopaed
of OMAS is a reliable and valid outcome measure for patients
4(1):947–951
with ankle fractures. BMC Musculoskelet Dis 14(1):1–8
13. Ahlborg HG, Rosengren BE, Järvinen TL, Rogmark C, Nilsson
J-Å, Sernbo I et al (2010) Prevalence of osteoporosis and inci-
Publisher's Note Springer Nature remains neutral with regard to
dence of hip fracture in women-secular trends over 30 years. BMC
jurisdictional claims in published maps and institutional affiliations.
Musculoskelet Dis 11(1):1–7
14. Den Hartog D, Van Lieshout EM, Tuinebreijer WE, Polinder
S, Van Beeck EF, Breederveld RS et al (2010) Primary

Authors and Affiliations

Anteneh Damena Kelemework1 · Abiy Worku Haile1 · Samuel Debas Bayable2

1
Anteneh Damena Kelemework Department of Orthopedics and Traumatology, Addis Ababa
antehehdamena@yahoo.com Burn, Emergency and Trauma (AaBET) Hospital, St. Paul
Millennium Medical College, Addis Ababa, Ethiopia
Abiy Worku Haile
2
abiyworku58@gmail.com Department of Anaesthesia, College of Medicine and Health
Science, Debre Markos University, Debre Markos, Ethiopia

13

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